Thanks Stephanie for a great case. This is a young patient with a history of smoking meth and alcohol dependence coming in with acute abdominal pain, found to have ischemic bowel, leukocytosis and AKI ultimately diagnosed with a descending aortic dissection.

) We discussed the utility of a D-dimer in diagnosis of aortic dissection. If < 500 ng/mL it has an excellent negative likelihood ratio (LR- 0.06) but not a good positive LR in a meta analysis (Am J Cardiol 2011;107(8):1227-34)

) “Trust but verify” This case involved a prolonged outside hospital stay prior to transfer and perhaps personal review of the primary data and imaging could have led to an earlier diagnosis.